DESCRIPTION: Fibromyalgia Syndrome (FMS) adversely affects patient lives and they are high utilizers of health care. Exercise programs have demonstrable in benefit for FMS patients. Nevertheless attrition rates from such programs are substantial, and long-term benefits are compromised by the failure of people with FMS to incorporate self-directed exercise into their lifestyles. A basic premise of the current application is that the non-participation and non-adherence to exercise programs demonstrated by FMS patients often reflect avoidance based on fears that activity will result in greater fatigue or pain. Anticipated and actual fear of physical activity may contribute to the disability of FMS sufferers, and to the high rates of attrition and nonadherence that they demonstrate to physical activation and other self-management programs. Two "components" of fear of activity can usefully be distinguished - Maladaptive beliefs about the threat posed by physical activity, and emotional arousal when individuals actually experience activities that threaten to aggravate their pain or fatigue. This analysis suggests that treatments directed towards maladaptive beliefs and excessive emotional arousal should help FMS patients overcome their activity avoidance, and thereby improve their level of function. This application is a continuation of R01AR 44724," Subgroups of FMS: Symptoms, Beliefs, and Tailored Treatments." The central Aims of this application are to extend previous work by: 1) measuring participant fear of movement, and 2) evaluating the effectiveness of treatments designed to reduce disability among FMS sufferers by reducing their fear and avoidance of physical activity by. Treatments will target either reduction of fear arousal (exposure therapy [ET]), reduction of maladaptive thoughts (cognitive restructuring and skills training [CR+ST]), or both [Combined [COMB]). It is posited that all 3 treatment protocols are effective in comparison to an Attention Control (AC) treatment, but that the relative effectiveness of the 3 regimens depends on the fear level of patients (i.e., that there is an interaction between fear level and treatment). The key premise is that whereas CR+ST is a robust form of treatment that can provide some benefit for most FMS patients by addressing maladaptive beliefs and coping strategies, ET is a more targeted approach that is particularly appropriate for FMS patients with high levels of fear. COMB treatment potentially produces the best overall outcome, since it incorporates both CR+ST, which is relevant to all participants, and ET, which is relevant to high fear participants.